Medical device delivery system and method

ABSTRACT

A tendon repair implant delivery system and methods incorporating a guide member having a temporary fixation member on or adjacent to the distal end. The point of fixation defines a target site for placement of the tendon repair implant which is subsequently affixed to the tendon.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application claims the benefit of U.S. Provisional PatentApplication Ser. No. 61/162,234, filed Mar. 20, 2009, and is related toU.S. patent application Ser. No. 12/684,774, filed Jan. 8, 2010, both ofwhich are incorporated herein by reference.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specificationare herein incorporated by reference to the same extent as if eachindividual publication or patent application was specifically andindividually indicated to be incorporated by reference.

FIELD OF THE INVENTION

The present invention relates generally to orthopedic medicine andsurgery. More particularly, the present invention relates to methods andapparatus for delivery of a medical device within a patient, such aswhen treating articulating joints.

BACKGROUND OF THE INVENTION

The shoulder joint is found where the head of the humerus mates with ashallow depression in the scapula. The movement of the humerus relativeto the scapula is controlled by a number of muscles including: thedeltoid, the supraspinatus, the infraspinatus, the subscapularis, andthe teres minor. Various patterns of activating these muscles createvarious rotational moments because the shoulder joint has no fixed axis.The tendons linking the supraspinatus, the infraspinatus, thesubscapularis, and the teres minor to the humerus are typically referredto as the rotator cuff tendons. Some studies suggest that 85% of peopleover the age of 65 have some degree of rotator cuff damage. This damagemay include thinning, fraying, and/or tearing of the rotator cufftendons. Various factors may contribute to this rotator cuff damage.These factors include aging, overuse of the shoulder, and wearing of thetendons. Wearing of the tendons can occur, for example, when the rotatorcuff tendons rub against a bone (e.g., the acromium of the scapula).

SUMMARY OF THE INVENTION

In accordance with various aspects of the present disclosure, a tendonrepair implant and delivery system is provided that, in some embodimentsincludes a guide member having a temporary fixation member disposedadjacent to or on a distal end thereof. In some embodiments, thetemporary fixation member is disposed proximate the distal end of theguide member. The guide member can be arthroscopically inserted to animplantation site and temporarily fixed at the site. A tendon repairimplant including a sheet-like structure disposed in a collapsedconfiguration can be disposed over the guide member for slidablepositioning to a target site.

The tendon repair implant can be pleat folded to the collapsedconfiguration and upon delivery to the target site assume an expandedshape.

The temporary fixation member can include a projection for piercing atendon to provide a fixed target site for delivery of the tendon repairimplant. The fixation member can also include a retractable barb fortemporarily fixing the fixation member to the tendon. Alternatively, thetemporary fixation member can include a threaded projection.

In some embodiments, the system of the present invention can include atendon repair implant delivery tool which assists in placing andaffixing the tendon repair implant to the tendon. The tendon repairimplant delivery tool can include a support ring tube defining a lumenwithin which is disposed an anchor. Further, a pull wire is disposedwithin the lumen defined by the support ring tube and extends through achannel defined by the anchor. The pull wire can include a flangeadjacent a proximal end of the anchor with the flange having a diametergreater than a width of the channel such that force applied to the pullwire causes the flange to deploy the anchor into adjacent tissue.

In some embodiments, the present invention also includes a method forpositioning a tendon repair implant to overlay at least a portion of asupraspinatus tendon in the shoulder of a patient. The method includesproviding an implant delivery device including a guide member having atemporary fixation member thereon which is then positioned with a distalportion of the guide member adjacent a bursal side of the supraspinatustendon at a target site. The guide member is temporarily fixed to targetsite with the temporary fixation member. The tendon repair implant isadvanced over the guide member for delivering the tendon repair implantto the target site and fixed to the supraspinatus tendon. The guidemember is then removed from the target site. In some exemplary methods,the distal portion of the guide member is inserted from the front orback of the patient to a position adjacent the supraspinatus tendon. Theguide member may be oriented so that it is generally parallel or tangentto an outer surface of the supraspinatus tendon.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is an isometric view of a shoulder including a humerus and ascapula.

FIG. 1B and FIG. 1C are cross-sectional views illustrating two states ofan exemplary temporary fixation mechanism.

FIG. 2 is a plan view of an exemplary tendon repair implant deliverysystem.

FIG. 3 is a cross-sectional view illustrating a distal portion of anexemplary tendon repair implant delivery system.

FIG. 4A is a top view of anchor delivery device.

FIG. 4B is a plan view showing a support ring of anchor delivery deviceoverlaying a tendon repair implant.

FIG. 4C is a cross-sectional view of an anchor delivery device.

FIG. 4D is an additional cross-sectional view of the anchor deliverydevice shown in FIG. 4C.

FIG. 5 is an enlarged view of an anchor shown in FIG. 4C.

FIG. 6 is a flow chart describing a method for treating a patient.

DETAILED DESCRIPTION

The following detailed description should be read with reference to thedrawings in which similar elements in different drawings are numberedthe same. The drawings, which are not necessarily to scale, depictillustrative embodiments and are not intended to limit the scope of theinvention.

Related U.S. application Ser. No. 12/684,774 filed Jan. 8, 2010 andentitled Impantable Tendon Protection System and Related Methods,provides an example of a medical device that may be delivered into apatient's shoulder joint through a cannula. During such an arthroscopicprocedure, a surgeon's field of view through the cannula or arthroscopeis typically very short. Accordingly, it can be difficult to accuratelylocate a target site for permanently implanting or temporarily placingsuch a medical device. Further, once a device is placed adjacent thetarget site and/or unfurled, many or all of the landmarks used by thesurgeon to locate the target sight may be obscured. In the particularsituation of the device being implanted as described in the aboveapplication, the target site may be spherically shaped and compriseslippery tissue, making placement of the implant even more difficult.

During such a delivery procedure, it may be desirable to firstaffirmatively locate the target site to which the medical device will beattached, and temporarily attach a locating guide to the target site toaid in delivering the medical device, according to aspects of thepresent detailed description. Once the medical device is attached to thetarget site, the located guide may be detached and removed. While thedescriptions below and associated drawings refer to implanting a tendonprotection device in a shoulder joint, in particular a sheet-likestructure or disk-like structure, the system and method described hereinand modified versions thereof may also be used to aid in temporarily orpermanently placing other devices in other locations within a patient.

FIG. 1A is an isometric view of a shoulder 20. Shoulder 20 includes ahumerus 22 and a scapula 24. Scapula 24 comprises an acromium 26 and aglenoid fossa 28. The movement of humerus 22 relative to scapula 24 iscontrolled by a number of muscles including: the deltoid, thesupraspinatus, the infraspinatus, the subscapularis, and the teresminor. For purposes of illustration, only the supraspinatus 30 is shownin FIG. 1. With reference to FIG. 1, it will be appreciated that adistal tendon 32 of the supraspinatus 30 meets humerus 22 at aninsertion point.

In FIG. 1, a head 34 of humerus 22 is shown mating with glenoid fossa 28of scapula 24 at a glenohumeral joint 38. In FIG. 1, a subacromial bursa36 is shown extending between acromium 26 of scapula 24 and head 34 ofhumerus 22. Subacromial bursa 36 is shown overlaying supraspinatus 30 inFIG. 1. Subacromial bursa 36 is one of over one hundred and fifty bursaefound the human body. Each bursa comprises a fluid filled sac. Thepresence of these bursae in the body reduces friction between bodilytissues. Injury and/or infection of the bursa can cause it to becomeinflamed. This condition is sometimes referred to as bursitis.

A locating guide 100 is also shown in FIG. 1. Locating guide 100comprises a shaft 102 having a proximal end and a distal end. A handle104 is fixed to the proximal end of shaft 102. In FIG. 1, a distalportion of shaft 102 is shown extending into an anterior side ofshoulder 20 from a location in the front of the patient. The distalportion of shaft 102 may be inserted into the shoulder so that thelongitudinal axis of the shaft extends generally parallel or tangent toan outer surface of a rotator cuff tendon (e.g., a supraspinatustendon). This allows maneuvering the distal end of the shaft 102 to atarget site for placing the tendon repair implant. In the exemplaryembodiment of FIG. 1, shaft 102 may be moved in a generally posteriordirection as the distal end of shaft 102 is advanced into the anteriorside of shoulder 20. Shaft 102 may be advanced in other directions toinsert the distal portion of shaft 102 without deviating from the spiritand scope of this detailed description. In some cases, for example,shaft 102 may be moved in a generally anterior direction as the distalend of shaft 102 is advanced into the posterior side of shoulder 20.Shaft 102 may also be moved in a generally superior or inferiordirection as the distal end of shaft 102 is advanced into shoulder 20 insome cases. In some useful embodiments, locating guide 100 includes atemporary fixation mechanism proximate the distal end of shaft 102. Amethod in accordance with the present detailed description may includetemporarily fixing the distal end of a shaft to a target site andadvancing a tendon repair implant, which can include a sheet-likestructure or tendon disk, over the shaft for delivering the implant tothe target site.

FIG. 1B and FIG. 1C are cross-sectional views illustrating two states ofan exemplary temporary fixation mechanism 108. In FIG. 1B, temporaryfixation mechanism 108 is shown in a retracted state. In FIG. 1C,temporary fixation mechanism 108 is shown in a fixing state.

Shaft 102 of locating guide 100 comprises core wire 130 and a guidesheath 132. With reference to FIG. 1C, it will be appreciated thatlocating guide 100 includes a selectively deployable barb 120. In theembodiment of FIG. 1, barb 120 is biased to extend away from alongitudinal axis of core wire 130 as shown in FIG. 1C. In theembodiment of FIG. 1B, however, guide sheath 132 is urging barb 120toward the longitudinal axis of core wire 130. In FIG. 1C, barb 120 isshown extending through an aperture defined by the wall of guide sheath132. In one exemplary method of use, the distal end of shaft 102 ispositioned adjacent a target site and inserted into the tendon tissue.The barb 120 is then deployed by moving guide sheath 132 longitudinallywhich temporarily affixes the locating guide 100 to the tendon forproviding a track to deliver the tendon repair implant. Whenimplantation is complete, the guide sheath 132 can be returned to itsoriginal position which urges the barb 120 against the core wire andreleases the tendon. In an alternative embodiment (not shown), a helicalscrew tip may be employed on the distal end of core wire 130 totemporarily secure guide 100 to the tissue with a twisting motion ofcore wire 130. The temporary fixation structure can also comprise aprojection that inserts into the tendon and holds or fixes a lateralposition but can be released from the position by lifting the projectionout of the tendon. A suture passed through the tendon may also be usedto secure guide 100.

FIG. 2 is a plan view of an exemplary tendon repair implant deliverysystem 140. The tendon repair implant can be a sheet-like or disk-likestructure that overlays a portion of a tendon when implanted. In theembodiment of FIG. 2, tendon repair implant delivery system 140comprises a delivery system sheath 142 and a handle 104. In theexemplary embodiment of FIG. 2, handle 104 has a pistol grip shape. Itwill be appreciated that handle 104 may have various shapes in additionto the exemplary shape shown in FIG. 2.

In the embodiment of FIG. 2, a tendon repair implant which comprises asheet-like or disk-like structure 134 is disposed inside a distalportion 136 of delivery system sheath 142. Tendon repair implantdelivery system 140 may be used to deploy tendon repair implant 134within the body of a patient. Some methods in accordance with thisdescription include attaching the implant to a tendon using a pluralityof anchors. Tendon repair implant delivery system 140 may include ananchor delivery device for this purpose. In some useful embodiments, theanchor delivery device is capable of delivering a plurality of anchorsfor attaching the tendon repair implant to the tendon.

Tendon repair implant delivery system 140 may be used to perform variousfunctions including deploying a sheet-like or disk-like structure withinthe body of a patient and anchoring the structure to a tendon. Tendonrepair implant delivery system 140 includes a plurality of controls thatmay be used on conjunction with the various functions that can beperformed using delivery system 140. The controls of delivery system 140include a knob 144, a slide button 146, a trigger 148, and a togglinglever 150.

In the embodiment of FIG. 2, the position of delivery system sheath 142may be altered by moving slide button 146 which is mechanically linkedinternally to delivery system sheath 142. Two positions of slide button146 are shown in FIG. 2. In FIG. 2, a first position is shown with solidlines and a second position is shown with dashed lines. When slidebutton 146 is in the first position, implant delivery sheath will assumethe advanced position shown in FIG. 2. When slide button 146 is in thesecond position, delivery system sheath 142 will assume a retractedposition.

Knob 144 of implant delivery system 140 may be used to operate alocating guide 100. For example, knob 144 may be used to actuate atemporary fixation mechanism of locating guide 100. Knob 144 may causethe temporary fixation mechanism of locating guide 100 to alternatebetween the retracted state and the fixing state. When the temporaryfixation mechanism is in the fixing state, it will selectively fix thedistal end of locating guide 100 to a target site. For example, knob 144may be mechanically connected to sheath 132, depicted in FIG. 1B suchthat actuating knob 144 results in longitudinal movement of sheath 132to deploy or retract the barb as necessary to temporarily fix the distalend of the location member.

Implant delivery system 140 also includes a toggling lever 150. Asupport ring sheath of implant delivery system 140 may be advanced andretracted using toggling lever 150. Toggling lever 150 may be movedbetween a first position and a second position. In FIG. 2, the firstposition of toggling lever 150 is shown with solid lines and the secondposition of toggling lever 150 is shown with dashed lines.

When the support ring sheath is retracted, support ring tube will form asupport ring. In some embodiments, a plurality of anchors are disposedinside the support ring tube. For example, six anchors may be evenlyspaced along the support ring tube. In the embodiment of FIG. 2, trigger148 may be used to dispense the anchors. In some embodiments, one anchorwill be dispensed each time trigger 148 is actuated. In otherembodiments, two or more anchors will be dispensed each time trigger 148is actuated.

FIG. 3 is a cross-sectional view further illustrating a distal portion136 of delivery system sheath 142. In FIG. 3, a tendon repair implant134 can be seen residing inside a lumen defined by delivery systemsheath 142. In the embodiment of FIG. 3, a locating guide 100, animplant push rod 152, and an anchor delivery device 154 are alsodisposed in the lumen defined by delivery system sheath 142.

Tendon repair implant 134 of FIG. 3 comprises a first lateral fold 156and a second lateral fold 158. An intermediate portion 160 of tendonrepair implant 134 is disposed between first lateral fold 156 and secondlateral fold 158. With reference to FIG. 3, it will be appreciated thata shaft 102 of locating guide 100 extends through a hole in intermediateportion 160 of tendon repair implant 134.

In FIG. 3, a distal portion 162 of tendon repair implant 134 can be seenextending between first lateral fold 156 and an outer edge 166 of tendonrepair implant 134. A proximal portion 164 of tendon repair implant 134can be seen extending between second lateral fold 158 and outer edge 166of tendon repair implant 134 in FIG. 3. Tendon repair implant 134 mayalso include a plurality of longitudinal folds (not visible in FIG. 3).For example, tendon repair implant 134 may be folded into a pleatedshape including a plurality of longitudinal folds. In some embodiments,the tendon repair implant is folded or otherwise compacted to acollapsed configuration prior to insertion to the target or implantsite. When properly positioned at the target site the tendon repairimplant is reconfigured to an open or non-collapsed configuration tooverlay at least a portion of the tendon. The tendon repair implant maybe self-expanding such that when the implant is extended outside thesheath of the delivery system, it unfurls or expands to an open orsheet-like configuration.

In the embodiment of FIG. 3, locating guide 100 comprises a shaft 102.Shaft 102 comprises a guide sheath 132 disposed about core wire 130. Inthe embodiment of FIG. 3, an implant push rod 152 is disposed aboutguide sheath 132 of shaft 102. Implant push rod 152 may by used to urgetendon repair implant 134 distally along shaft 102 of locating guide100.

In the embodiment of FIG. 3, an exemplary anchor delivery device 154 isdisposed in the lumen defined by delivery system sheath 142. Anchordelivery device 154 comprises a support ring tube 170 and a support ringsheath 172 that is disposed about support ring tube 170. Support ringtube 170 is biased to form a support ring when support ring sheath 172is in a retracted position. Support ring tube 170 assumes a contractedshape when support ring tube 170 is retracted into a lumen defined bysupport ring sheath 172. The operation of anchor delivery device 154 maybe further explained with reference to the next figure.

FIG. 4 includes a plurality of additional views further illustratinganchor delivery device 154 shown in the previous figure. FIG. 4A is atop view of anchor delivery device 154. In the embodiment of FIG. 4A,support ring tube 170 is forming a support ring 174. Support ring 174 ofFIG. 4A comprises a portion of support ring tube 170 that is extendingbeyond support ring sheath 172. In the embodiment of FIG. 4B, supportring tube 170 will be urged to assume a contracted shape when supportring tube 170 is retracted into a lumen defined by support ring sheath172.

FIG. 4B is a plan view showing support ring 174 of anchor deliverydevice 154 overlaying a tendon repair implant 134. In some exemplarymethods in accordance with the present description, support ring 174 isused to hold tendon repair implant 134 in intimate contact with atendon. Support ring 174 of FIG. 4A comprises a portion of support ringtube 170 that is extending beyond support ring sheath 172. A shaft 102of a locating guide 100 can be seen extending through a hole in tendonrepair implant 134 in FIG. 4B.

FIG. 4C is a cross-sectional view of anchor delivery device 154. In someembodiments, anchor delivery device 154 comprises a plurality of anchors176 that can be used to fix an implant to a tendon. One anchor 176 isvisible in FIG. 4C. The anchor can be a blind anchor that is insertedinto the tendon on the bursal side. In the embodiment of FIG. 4C, anchor176 defines a channel 178. In FIG. 4C, a pull wire 180 can be seenextending through channel 178. A top surface 182 of anchor 176 and abottom surface 184 of anchor 176 are both visible in FIG. 4C. Topsurface 182 defines an open side of channel 178.

Anchor 176 and pull wire 180 are both disposed inside a lumen defined bya support ring tube 170. The wall of support ring tube 170 defines aplurality of apertures 186. Each anchor 176 of anchor delivery device154 may be selectively urged through an aperture 186 to anchor animplant to a tendon.

With reference to FIG. 4C, it will be appreciated that pull wire 180 hasa plurality of flanges 188. In FIG. 4C, a flange 188 can be seencontacting a proximal end of anchor 176. Flange 188 and pull wire 180may apply force to anchor 176. For example, force from pull wire 180 andflange 188 may be used to urge a distal point 190 of anchor 176 throughan implant and into a tendon.

FIG. 4D is an additional cross-sectional view of anchor delivery device154. In FIG. 4D, anchor 176 is shown extending through an aperture 186defined by the wall of support ring tube 170. In the embodiment of FIG.4D, an anchor deflector 193 is applying a deflecting force to anchor176. This deflecting force is represented with an arrow FD in FIG. 4D.In FIG. 4D, an arrow FA is used to represent a force that flange 188 isapplying to anchor 176. An additional arrow FB is also visible in FIG.4D. Arrow FB represents a pulling force that is being applied to pullwire 180. In the embodiment of FIG. 4, distal point 190 of anchor 176has penetrated the cuff of a tendon repair implant 134. Distal point 190is shown residing in a tendon.

FIG. 5 is an enlarged view of anchor 176 shown in the previous figure.With reference to FIG. 5, it will be appreciated that anchor 176comprises a body 198 having a distal point 190. Body 198 of anchor 176defines a channel 178. Body 198 includes a first notch 192, a secondnotch 194, and a third notch 196. First notch 192 defines a first barb122 of anchor 176. Second notch 194 and third notch 196 define a secondbarb 124 and a third barb 126 respectively. The barbs of anchor 176 mayexpand outward once anchor 176 is deployed.

FIG. 6 is a flow chart describing a method for treating a patient. Amethod in accordance with the present description may include accessinga target site in the body of a patient. In some applications,arthroscopic equipment may be used to access a joint (e.g., a shoulderjoint) in the patient's body. The arthroscopic equipment may include,for example, a cannula. The cannula may be positioned so that the distalend of the cannula is inside the shoulder of the patient. The cannuladefines a lumen. Various devices may be advanced through a proximalopening of the cannula and into the lumen defined by the cannula. Thecannula then guides the device into the shoulder.

A method in accordance with the present detailed description may includeanchoring the distal end of a guide shaft to a target site and advancinga tendon repair implant over the shaft for delivering the tendon repairimplant to the target site. Some methods in accordance with thisdescription include attaching the implant to a tendon using a pluralityof anchors. An anchor delivery device may be used for this purpose. Insome useful embodiments, the anchor delivery device is capable ofdelivering a plurality of anchors for attaching the implant to thetendon.

A therapeutic agent may be applied to the tendon repair implant prior topositioning at the target site. Therapeutic agents can include: drugs,anti-inflammatory agents, painkillers, antibiotics, proteins, hormones,growth factors, and growth factor sources. Growth factor sources mayinclude, for example, platelets and platelet rich plasma (PRP). A tendonrepair implant may contain calcium chloride for causing plateletaggregation, which will cause release of growth factors. Examples ofgrowth factors that may be suitable in some applications include but arenot limited to heparin binding growth factor (“HBGF”), platelet-derivedgrowth factor (“PDGF”), transforming growth factor alpha or beta(“TGF-.alpha.” or “TGF-.beta.”), basic fibroblast growth factor(“bFGF”), epidermal growth factor (“EGF”), and vascular endothelialgrowth factor (“VEGF”). Examples of hormones that may be suitable insome applications include but are not limited to insulin, glucagon, andestrogen. It will be appreciated that therapeutic agents can bedelivered to the target site apart from the tendon repair implant,either before or after placement of the implant.

While exemplary embodiments of the present invention have been shown anddescribed, modifications may be made, and it is therefore intended inthe appended claims to cover all such changes and modifications whichfall within the true spirit and scope of the invention.

1. A method for positioning a tendon repair implant to overlay at leasta portion of a supraspinatus tendon in the shoulder of a patient, themethod comprising the steps of: providing an implant delivery deviceincluding a guide member having a temporary fixation member thereon;positioning a distal portion of the guide member adjacent a bursal sideof the supraspinatus tendon at a target site; temporarily fixing thedistal portion of the guide member to the target site with the temporaryfixation member; advancing the tendon repair implant over the guidemember for delivering the tendon repair implant to the target site;fixing the tendon repair implant to the supraspinatus tendon; andremoving the guide member from the target site.
 2. The method of claim1, further comprising urging the tendon repair implant to assume acollapsed shape prior to the step of advancing the tendon repair implantover the guide member.
 3. The method of claim 2, wherein the tendonrepair implant is advanced over the guide member in the collapsed shape.4. The method of claim 3, wherein the tendon repair implant includes aself expanding sheet-like structure and the method includes allowing thesheet-like structure to assume an expanded shape.
 5. The method of claim3, further comprising urging the tendon repair implant to assume anexpanded shape.
 6. The method of claim 5, wherein the tendon repairimplant is urged to assume the expanded shape before fixing the implantto the tendon.
 7. The method of claim 1, wherein the step of positioningthe distal portion of the guide member includes inserting the guidemember from the front or back of the patient to a position adjacent thesupraspinatus tendon.
 8. The method of claim 1, wherein fixing thetendon repair implant to the tendon comprises fixing the implant to thetendon while the implant is held in contact with the tendon.
 9. Themethod of claim 8, wherein fixing the tendon repair implant to thetendon comprises advancing an anchor into the tendon.
 10. A tendonrepair implant and delivery system, comprising: a guide member having atemporary fixation member disposed on or adjacent to a distal endthereof; and, a tendon repair implant including a sheet-like structuredisposed in a collapsed configuration over the guide member for slidablepositioning to a target site.
 11. The tendon repair implant and deliverysystem of claim 10, wherein the collapsed configuration has a pleatfolded shape comprising a plurality of longitudinal folds.
 12. Thetendon repair implant and delivery system of claim 10, wherein: thesheet-like structure of the tendon repair implant includes anintermediate portion extending between a first lateral fold and a secondlateral fold, the intermediate portion defining a hole; and the guidemember extends through the hole in the intermediate portion of thesheet-like structure.
 13. The tendon repair implant and delivery systemof claim 10, wherein the sheet-like structure is capable of assuming anexpanded shape.
 14. The tendon repair implant and delivery system ofclaim 10, wherein the temporary fixation member includes a projectionfor piercing a tendon to provide a fixed target site for delivery of thetendon repair implant.
 15. The tendon repair implant and delivery systemof claim 14, further comprising a retractable barb for temporarilyfixing the fixation member to the tendon.
 16. The tendon repair implantand delivery system of claim 10, wherein the temporary fixation memberincludes a threaded projection.
 17. A tendon repair implant deliverytool comprising: a support ring tube defining a lumen; an anchordisposed within the lumen defined by the support ring tube; a pull wiredisposed within the lumen defined by the support ring tube; the pullwire extending through a channel defined by the anchor; the pull wireincluding a flange adjacent a proximal end of the anchor; and, theflange having a diameter greater than a width of the channel such thatforce applied to the pull wire causes the flange to deploy the anchorinto adjacent tissue.
 18. The tendon repair implant delivery tool ofclaim 17, further comprising: a sheath defining a sheath lumen wherein,the support ring tube is at least partially disposed in the sheath lumenand a distal portion of the support ring tube being biased to form asupport ring when the distal portion of the support ring tube isdisposed outside of the sheath lumen.
 19. The tendon repair implantdelivery tool of claim 17, further comprising a plurality of anchors andflanges disposed inside the support ring tube lumen defined by thesupport ring tube wherein force applied to the pull wire causesdeployment of the plurality of anchors into adjacent tissue.
 20. Thetendon repair implant delivery tool of claim 19, wherein the pluralityof anchors are simultaneously deployed.